432 THEINDIAN JOURNAL O~ PEDIATRICS R~.Nc.=.s 1. Jacobs RF, Abemathy RS. Management of tuberculosis in pregnancy and the newborns. Clin Perinatol 1988; 15 : 307- 319. 2. Nemir RH, O'Hare D. Congential tuber- culosis. Am J Dis Child 1985; 139 : 284-287. 1994;Vol.61. No. 4 3. Hageman J, Shulman S, Schreiber Met al. Congenital tuberculosis-critical reap- praisal of clinical firgiings and diagnostic procedures. Pediatrics 1980; 66 : 980- 984. 4. Nair PMC, Narang A. Management of a. baby of tuberculous mother. Indian Pediatr 1992; 29 : 797-801. Adrenal Hemorrhage in Asphyxiated Neonates and the Importance of Ultrasonography S/ikrii Kiifiik6diik, famail fslek, Hiiseyin Akan,* Murat Aydin, Cengiz Dilber and Nuran Gfittes Departments of Pediatrics and *Radialogy, Ondolo~z Mayis University, School of Medicine; Samsun, Turkey Adrenal hemorrhage is not rare in neonates. Massive adrenal hemorrhage diagnosed during life in neonates was first described in 1924.1 Adrenal gland is more prone to traumatic hemorrhage in the newborn in comparison with other groups, since it has a large volume and rich vascularity, z Sepsis, hemorrhagic abnormalities, hypoprothrombinemia, asphyxia and birth trauma are common risk factors for adrenal hemorrhage? Incidence of perinatal asphyxia varies from 1% to 1.5%. This incidence is 9% for neonates with gestational age younger than 36 weeks, and 0.5% for neonates with gestational age older than 36 weeks.' In asphyxia, blood flow to vital organs such as brain, myocardium and adrenal gland is preserved or increased; on the other hand, the blood flow to kidneys, intestines, muscles and skin is decreased due to selective vasoconstriction, s Because of that, asphyxiated neonates are prone to adrenal hemorrhage. So far, varied clinical pictures and con- troversies about the treatment of choice have been reported for adrenal hemor- rhage in neonates. Although some authors prefer surgical approach, s; the others ad- vocate conservative management. .,9 In this article, eight neonate cases diagnosed as .adrenal hemorrhage with clinical signs and laboratory findings between 1988 and 1993 are summarized in Table 1, 2, 3 and case 4 is presented in detail. CAsz REPorr In our neonatal unit, 4,620 patients were treated between 1988 and 1993. Two hundred and fifty one of them were diagnosed as asphyxiated neonate and fo|lowed up. When there were signs and symptoms of probable adrenal